|
| Author (year) | Study type/topic | Study population(s) | Type of surgery | POCD criteria | POCD assessment | Timepoint of assessment |
|
| Claes et al., 2018 [7] | Prospective cohort study
Incidence POCD cochlear implantation | 26 (16 male, 10 female)
≥55 years
POCD incidence 7 days post-op: 11.5% | Cochlear implantation | A z-score of change in MoCA scores ≥1.96. | (i) MoCA | (i) Baseline:
(ii) Day of surgery
(iii) Post-op:
(iv) 7 days |
| Duan et al., 2018 [8] | Prospective observational study
Glial cell line derived neurotropic factor as predictor for POCD | 80 (36 male/44 female)
20 healthy controls
>50 years
POCD incidence 7 days post-op: 47.5% | Elective heart valve replacement | At least 2 z scores >1.96.
Compared to 20 healthy controls matched by gender, age, and education. | (i) MMSE
(ii) Digit span test
(iii) Trail making test A
(iv) Digit symbol
(v) Modalities
clock drawing test | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 7 days |
| Gong et al., 2018 [9] | Cohort study
Incidence of POCD laparoscopic vs. open surgery | 70 (41 male/29 female)
32–85 years
POCD incidence 7 days post-op:
Open: 18.7%
Laparoscopic: 12.5% | Abdominal surgery | Patients with an MMSE score reduction of two. | (i) MMSE | (i) Baseline:
(ii) 1 day before
(iii) Post-op:
(iv) 1 and 7 days |
| Hayashi et al., 2018 [10] | Secondary analysis
6-minute walk distance and POCD | 181 (121 male/60 female)
≥ 60 years
POCD incidence 14 days post-op: 28% | Cardiac surgery | Significant decline in cognitive function based on a decrease of 2 or more in the MMSE score. | (i) MMSE | (i) Baseline:
(ii) Admission
(iii) Post-op:
(iv) 14 days |
| Hou et al., 2018 [11] | RCT
Deep versus light anesthesia and POCD | 60 (26 male/34 female)
≥60 years
POCD incidence 1 day post-op:
Low doses: 20%
High doses: 3% | Total knee replacement | A z-score of >1.96 using cross‐reference. | (i) MoCA | (i) Baseline:
(ii) Day of surgery
(iii) Post-op:
(iv) 1, 3, and 7 days |
| Konishi et al., 2018 [12] | Secondary analysis of prospective observational study (ACE study)
Incidence of POCD sevoflurane vs. propofol | 121 sevoflurane (77 male/44 female), 171 propofol (114 male/57 female)
≥60 years
POCD incidence 7 days post-op:
Sevoflurane: 20.2%
Propofol: 15% | Total hip replacement | ≥2 tests were at least 1.96 SD lower than the mean score of the matched control group after adjusting for expected change over time using controls or the combined z-score was less than −1.96. | (i) Auditory verbal learning test
(ii) Trail making test (parts A and B)
(iii) Digit symbol substitution test
(iv) Controlled oral word association test
(v) CERAD semantic fluency test (animals)
(vi) Grooved pegboard test (both hands) | (i) Baseline:
(ii) The week before surgery
(iii) Post-op:
(iv) 7 days
3, 12 months |
| Kumpaitiene et al., 2018 [13] | Prospective observational study
POCD and decreased cerebral oxygen saturation | 59 (32 male/24 female)
≥60 years
POCD incidence 7–10 days post-op: 37% | Coronary artery bypass graft surgery | The sum of all z-scores was >2 or at least two z-scores for separate tests were >2. | (i) MMSE
(ii) Rey auditory verbal learning test
(iii) Digit symbol substitution test and Schulte table
(iv) Digit span test
(v) Trail making test (parts A and B) | (i) Baseline:
(ii) Day before surgery
(iii) Post-op:
(iv) 7–10 days |
| Şahan et al., 2018 [14] | Pilot study
Cerebral oxygen changes | 40 (34 male/6 female)
≥60 years
POCD incidence 7 days post-op:
45% in target group
41% in control group | Coronary surgery | A drop of 1 standard deviation from baseline on two or more neuropsychological tests. | (i) Logical memory subtest
(ii) Clock drawing test
Visuospatial skill test
(iii) Word list generation test
(iv) Digit span subtest | (i) Baseline:
(ii) 2-3 days before surgery
(iii) Post-op:
7 days
(iv) 3 months |
| Zhang et al., 2018 [15] | Case control study
Goal-directed fluid therapy | 60 (40 male/20 female)
≥60
POCD incidence 21.67% | Spinal stenosis surgery | If one standard deviation of MoCA score was decreased one or more after surgery. | (i) MoCA | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 1, 3, and 7 days |
| Zhang et al., 2018 [16] | Cohort study
Propofol versus sevoflurane and cognitive function | 379 (263 male/116 female)
≥ 65 and <90 years
POCD incidence 7 days post-op:
Sevoflurane: 23.2%
propofol: 19.0% | Major cancer surgery (≥2 hours) | Two z scores in individual tests or the combined z score ≤1.96. | (i) Mental control
(ii) Paired associate verbal learning
(iii) Grooved pegboard (both hands)
(iv) Visual retention
(v) Digit symbol
(vi) Trail making (part A)
(vii) Digit span (forward and backward) | (i) Baseline:
(ii) Before surgery
(iii) Post-op:
(iv) 7 days |
| Zhang et al., 2018 [17] | Predefined exploratory subanalysis
Vitamin D deficiency and POCD | 123 (81 male/42 female)
≥65 years
POCD incidence 7 days post-op: 24.4% | Major cancer surgery | Two or more z-scores in individual tests or the combined z-score ≤−1.96. | (i) MMSE
Mental control and digit span (forward and backward)
(ii) Visual retention and paired associate verbal learning
(iii) Digit symbol subtest
(iv) Halstead–Reitan trail making test (part A)
(v) Grooved pegboard test | (i) Baseline:
(ii) Day before surgery
(iii) Post-op:
(iv) 7 days
(v) Telephone:
(vi) 30 days post-op |
| Cheng et al., 2019 [18] | Cohort study
Dexmedetomidine versus saline placebo and POCD | 535 (392 male/143 female)
100 patients with chronic gastroenteritis (reference normal values)
≥65 years
POCD incidence 7 days post-op:
Saline: 18%
Dexmedetomidine: 12% | Abdominal surgery | RCI ≤−1.96 or a z-score ≤−1.96 in at least two tests. | (i) Trail making test (parts A and B)
(ii) Digit symbol test
(iii) Brief visuospatial memory test-revised
(iv) Immediate recall and delayed recall
(v) Hopkins verbal learning test-revised
(vi) Forward and backward digit span test | (i) Baseline:
(ii) Day before surgery
(iii) Post-op:
(iv) Days 3 and 7
(iv) Telephone:
(v) After 1, 3, and 6 months |
| Daiello et al., 2019 [19] | Secondary analysis of an observational study
Association between POCD and postoperative delirium | 551 (231 male/320 female)
>65 years
Incidence POCD 1-month post-op: 47% | Major noncardiac surgery | A composite z-score of at least 1.96 across all tests, or z-scores for ≥2 tests scores at least 1.96. | (i) Rey visual verbal learning test
(ii) Concept shifting test
(iii) Stroop color-word test
(iv) Letter digit substitution | (i) Baseline:
(ii) Within 2 weeks before surgery
(iii) Post-op:
(iv) 1, 2, and 6 months |
| Gao et al., 2019 [20] | Prospective study
Risk factors of POCD | 257 (male 108/149 female)
≥65 years
POCD incidence 7 days post-op: 21.4% | Elective total joint arthroplasty | A z score >1.96 at least 2 times. | (i) MMSE
(ii) Word recognition, memory tests
(iii) Digit span test
(iv) Verbal fluency test
(v) Trail making test (part A)
(vi) Symbol digit test | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 7 days |
| Han et al., 2019 [21] | Cohort study
Cortisol ratio in saliva as predictor for POCD | 94 (65 male/29 female)
>60 years
POCD incidence 7 days post-op: 17% | Major cardiac surgery | A z-score of ≤−1.96 on at least 2 different tests | (i) The short story module of the Randt memory
(ii) Grooved pegboard test (dominant and nondominant)
(iii) Digit symbol subtest
(iv) Trail making test (part A)
(v) The verbal fluency test
(vi) Digit span (forward and backward)
(vii) Finger tapping
(viii) Block subtest | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 7 days |
| Holmgaard et al., 2019 [22] | Secondary analysis of a randomized trial
Cerebral oximetry and POCD | 153 (138 male/15 female)
≥55 years
POCD incidence: 29% at discharge, 8% after 3 months | Cardiac surgery (heart valve surgery, coronary artery bypass grafting, or both) | Two out of seven z-scores for individual tests or the composite z-score >1.96.
| (i) MMSE (≤24 excluded)
(ii) Visual verbal learning test
(iii) Concept shifting test
(iv) Stroop color word interference (SCWI) test
(v) Letter digit coding (LCD) test | (i) Baseline:
(ii) Before surgery
(iii) Post-op:
(iv) Day before discharge/after 8 days
(v) 2–4 months |
| Hongyu et al., 2019 [23] | Cohort study
Effect of penehyclidine hydrochloride on POCD | 90 (47 male/43 female)
>60 years
POCD incidence 7 days post-op:
A 53.3% (penehyclidine hydrochloride)
B 26.7% (atropine)
C 13.3% (saline) | Thoracoscopic surgery for lung cancer | Uneducated <17 points, primary education <20 points, and >6 years education <24 points. | (i) MMSE | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 1, 4, and 7 days |
| Kristek et al., 2019 [24] | Prospective RCT
Incidence of POCD effect levobupivacaine versus morphine | 70 (4 male/66 female)
≥65 years
POCD incidence day 1–discharge:
levobupivacaine: 9%
Morphine: 31% | Femoral fracture fixation | A decline in the MMSE score below 17 or a reduction in the MMSE score for ≥3 compared with the baseline on at least one measurement. | (i) MMSE | (i) Baseline:
(ii) Before surgery
(iii) Post-op:
(iv) Days 1–5
(v) Day of discharge |
| Lachmann et al., 2019 [25] | Prospective, observational study
Association between cerebral microbleeds and POCD | 65 (30 male/35 female)
>65 years
Incidence POCD 7 days post-op: 20% | Major elective surgery (>60 minutes) | RCI by Rasmussen et al., 2001. | (i) Paired associates learning
(ii) Verbal recognition memory
(iii) Spatial span time
(iv) Simple reaction time
(v) Grooved pegboard
(vi) Trail making tests | (i) Baseline:
(ii) Performed but not mentioned when.
(iii) Post-op:
(iv) 7 days
(v) 3 months |
| Langer et al., 2019 [26] | RCT pilot
Hypotension and POCD | 101 patients (53 male/
48 female)
33 age-matched controls
≥75 years
POCD incidence 3 months post-op: 9% | Elective noncardiac surgery | RCI was used
A z-score below −1.96 on at least 2 neuropsychological tests and/or the combined z-score below −1.96. | (i) MMSE
(ii) Stroop test
(iii) Symbol digit modalities test
(iv) Trail making test (parts A and B)
(v) Immediate and delayed recall
(vi) Free and cued selective reminding test (FCSRT)
(vii) Verbal phonemic fluency test
(viii) Denomination test | (i) Baseline:
(ii) Before surgery
(iii) Post-op:
(iv) After 3 months |
| Li et al., 2019 [27] | Prospective, observational study
Association between serum levels S100A12 and POCD | 186 patients (male 78/female 108)
186 controls (for serum)
≥65 years
POCD incidence 7 days post-op: 35% | Femoral neck fracture or intertrochanteric fracture | Two or more z-scores in individual tests or the combined z-score ≤−1.96. | (i) Visual verbal learning test
(ii) Concept shifting test
(iii) Stroop color word interference test
(iv) Paper and pencil memory scanning test
(v) Letter digit coding
(vi) Four boxes test | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 7 days |
| Li et al., 2019 [28] | Prospective RCT preliminary trial
Sedation by dexmedetomidine, midazolam, or propofol and POCD | 205 (72 male/133 female)
≥65 years
POCD incidence 7 days post-op: 36.6% | Hip or knee arthroplasty | RCI score less than −1.96 on ≥2 tests and/or combined z-score less than −1.96. | (i) Montreal cognitive assessment (MoCA)
(ii) Stroop color-word test (SCWT)
(iii) Associative learning and memory test
(iv) Digit symbol test
(v) Digit span test | (i) Baseline:
(ii) Before surgery
(iii) Post-op:
(iv) 7 days
(v) Telephone:
(vi) 1 year using 5-minute MoCA protocol |
| Quan et al., 2019 [29] | RCT
Light vs. deep anesthesia and POCD | 120 (66 male/54 female)
≥60 years
POCD incidence 7 days post-op:
Deep: 19.2%
Light: 39.6% | Abdominal surgery | Deterioration in postoperative performance by 1 or more standard deviations on 2 or more tests. | (i) Mental control
(ii) Digit span (backward and forward)
(iii) Paired associate verbal learning
(iv) Digit symbol subtest
(v) Visual retention-Halstead–Reitan trail making test (part A)-grooved pegboard test | (i) Baseline:
(ii) Before surgery
(iii) Post-op:
(iv) 7 days
(v) 3 months |
| Sánchez et al., 2019 [30] | Longitudinal study
Optimization of delirium assessment | 1500
≥70 years
POCD incidence: | Elective surgery
Thoracic, cardiac, vascular, proximal big joints and spine, gastrointestinal, genitourinary, and general elective surgery | A test value ≤0.5 standard deviations, normalized for age, gender, and education, in one of these tests. | (i) Montreal cognitive assessment (MoCA)
(ii) Digit span backwards
(iii) Trail making test A and B | (i) Baseline:
(ii) Preadmission
(iii) Before surgery
(iv) Post-op:
(v) 2, 6, and 12 months |
| Wang et al., 2019 [31] | Prospective cohort study
Glucocorticoid receptor, FKBP51, and POCD in elderly | 111 (49 male/62 female)
≥65 years
POCD incidence 7 days post-op: 28.3% | Hip fracture surgery | A decline of 1 or more standard deviations (SDs) in 2 or more tests. | (i) MMSE
(ii) Verbal learning
(iii) Mental control
(iv) Digit span (forward and backward)
(v) Visual retention
(vi) Grooved pegboard test (both hands)
(vii) Digit symbol test
(viii) Trail making test (part A) | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 7 days |
| Wang et al., 2019 [32] | Cohort study
circRNA_089763 as biomarker for POCD | 35 (30 male/5 female)
40–90 years
POCD incidence 7 days post-op: 34% | Coronary artery bypass grafting | Reduction in postoperative test score compared with the preoperative test score ≥20% in ≥2 tests. | (i) Stroop color and word test
(ii) Trail making test
(iii) Digit symbol substitution test
(iv) Verbal learning test
(v) The symbol digits modalities test | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 7 days |
| Wang et al., 2019 [33] | Prospective observational cohort study
Smoking history and risk for POCD | 382 (189 male/193 female)
≥60 years
POCD incidence 5 days post-op: 50.4% | Noncardiac surgery | A z-score of ≥1.96. | (i) MMSE
(ii) Concept shifting test
(iii) Stroop color-word interference test | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 5 and 7 days |
| Wang et al., 2019 [34] | RCT
Ropivacaine intercostal nerve block and POCD | 100 (50 male/50 female)
Age: 43–46 years
POCD incidence:
With block: 21%
Without block: 39% | Thoracotomy for esophageal cancer | Score less than or equal to 25 points, or if more than 2 points reduction on the MMSE score after surgery compared with the score before surgery. | (i) MMSE | (i) Baseline:
(ii) 1 hour before surgery
(iii) Post-op:
(iv) 2, 12, and 24 hours |
| Zhang et al., 2019 [35] | Cohort study
Effects of fentanyl versus sufentanil on POCD | 96 (47 male/49 female)
≥65 years
POCD incidence 7 days post-op:
Fentanyl: 11.9%
Sufentanil: 6.2% | Open surgery | A drop of 1 standard deviation from baseline on two or more items. | (i) MoCA | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 1, 7 days |
| Zhang et al., 2019 [36] | Cohort study
Risk factors for POCD | 77 (42 male/35 female)
≥65 years
POCD 7 days post-op: 24.7% | Colorectal surgery | z-score was greater than 1.96 or the combined z- score was ≥1.96. | (i) MMSE
(ii) Visual verbal learning test
(iii) Digit span test
(iv) Digit symbol substitution test | (i) Baseline:
(ii) 1 day before surgery
(iii) Post-op:
(iv) 7 days |
|
